News and Views on Social Marketing and Social Change

90 posts categorized "Social Media"

A review of the research and evidence for the use of social network sites (SNS) to improve cardiovascular health, “Digital social networks and health," was published in the 30 April 2013 issue of Circulation, a journal of the American Heart Association. In this article, Alex Bornkessel (aka Social Butterfly) and I document the emergence of social media, and specifically SNS, and their impact on health
information-seeking and health-related behaviors. We survey user
behavior on SNS to document how health information is being transformed from an individual or clinical
endeavor into a social health experience, and the implications this has for patient privacy and confidentiality in digital social networks. The research evidence for how SNS may influence health
behaviors is also reviewed. We conclude by offering recommendations for
practice to optimize the use of social media and its contribution to
improved health outcomes, and pose a series of questions to guide the
development of a research agenda in this area. The article is available
for free download.

"Social media, and especially SNS, are moving us away from an individual view of health to one that encompasses social connections among patients, their families and caregivers, and their healthcare provider team. New media technologies are going to increase and sustain this trend. We have shown that the research evidence is quite limited for how SNS can be effectively and efficiently used to improve health in an equitable way across the population. We have demonstrated where and how SNS can be put into practice now, and identified some of the important concerns and questions that research in this area might address" (Lefebvre & Bornkessel, 2013, p. 1835).

The rise in the use of social network sites (SNS) among internet users over the past 7 years has been dramatic. In 2005 less than 10% of any age group on the internet reported using a SNS, and by 2012 two-thirds of all internet users said that they use at least one SNS. Note that I use SNS here as suggested by boyd and Ellison (2007) who make the important distinction between social networking sites in which initiating relationships between strangers is a major activity (such as on dating sites) and social network sites that allow people to make their networks visible to others. It may seem a small point unless you are the user.

Today Duggan and Brenner (2013) report the demographic characteristics of the users of SNS from the latest Pew Internet and American Life survey. They note statistically significant differences for gender with women more likely to be users than men (71% to 62%); age differences predictably favored younger age groups being more involved with SNS; and people living in urban areas were more likely than people living in suburban or rural areas to be using SNS. No differences in SNS use were noted for race/ethnicity, education attainment or household income.

Digging deeper into SNS use, 67% of all SNS users were on Facebook and it is especially popular with women and adults ages 18-29 (though 57% of 50-64 year-olds, and 35% of people age 65+ are using it as well). Twitter is used by 16% of internet users; the 18-29 year olds, African-Americans and urban residents were significantly more likely to use it than other groups. Women, adults under 50 years of age, whites and people with some college education or an annual household income greater than $50,000 are more likely to use Pinterest (overall it was used by 15% of all internet users). Using Instagram is reported by 13% of internet users, and was especially appealing to the 18-29 age group, African-Americans, Latinos, women and urban residents.

The popularity of SNS sites seems to be plateauing, and even declining slightly, among all age groups. There is also selection and concentration of SNS users occurring as striking differences do emerge among users of specific SNS. You might also want to compare these figures with the SNS demos we were talking about four years ago.

I don’t have the time or capacity to sort through the many
articles that appear in the academic journals on social media, and I suspect
many of you don’t either. But shifting the practice of social media marketing
from stories to evidence is, in the long run, a more sustainable model to have
impact.

John Wihbey of the Journalist’s Resource (JR), Shorenstein
Center on the Press, Politics and Public Policy at the Harvard Kennedy School,
has done an admirable job for us this year in putting together a top 10 list of
social media research articles (and thanks to @jbenton for
bringing it to my attention!).

A
person is much more likely to join Facebook if that person has friends on
Facebook who do not know each other — a structurally diverse network —
than if that person’s friends are all connected on the site. “The number
of distinct social contexts represented on Facebook … predicts the
probability of joining.”

An
invitation to join Facebook that listed four unrelated site users sent to
a potential user was more than twice as likely to prompt the individual to
join than an invitation that listed four connected users. “It is not the
number of people who have invited you, nor the number of links among them,
but instead the number of connected components they form that captures
your probability of accepting the invitation.”

Once a
user joins Facebook, the structural diversity of his or her network also
impacts the level of engagement: more active Facebook users have friends
on the site spanning numerous social circles. “Simply counting connected
components leads to a muddled view of predicted engagement…. However,
extending the notion of diversity according to any of the definitions
above suffices to provide positive predictors of future long-term
engagement.”

The researchers conclude that “these findings suggest an
alternate perspective for recruitment to political causes, the promotion of
health practices and marketing; to convince individuals to change their
behavior, it may be less important that they receive many endorsements than
that they receive the message from multiple directions.”

What caught my attention is the validation of an idea I have
talked about for several years – media multiplexity. Three points I have made
bear repeating for social media practitioners, especially those engaged with
using social media for behavior change:

People are rapidly learning how to
incorporate new media and social networking into their daily lives. As they
become more comfortable, and in control, of these experiences, it will be the
change agents and organizations that learn how to work with the 'social'
context of these media that will be most successful. [Social media and social
ties]

Social technologies succeed when they fit into the social lives and
practices of those who engage with the technology. [Introduction to social
media]

What the findings of this study suggest is that we need to understand
people’s social networks (online and off) and then uncover ways in which the
disparate networks a person has can be engaged for change. The other
implication is that people who are fairly insular in the networks they have
(for example, all their friends know each other) are going to be much less open
to our offers for change and also less likely to be participating on social network sites. Shifting from thinking about 'messages that will change people' to 'networks that support people changing' is a big change for many researchers and practitioners. To start thinking about social networks and change, take a
look at Maybe IT IS all about social networks.

It has only been a few years, but it is clear to many people that social media has moved beyond experimentation and anecdotes. Public, nonprofit and commercial users now need to justify why they continue to use social media and, in some quarters, are demanding evidence that it impacts bottom-lines - whether they are financial returns, social impact or behavior change. And it is clear that the newest versions of bean-counting exercises - tabulating things such as 'followers' and 'fans' - are no longer sufficient for defining "success." Such 'beans' are easy to measure, but not particularly valuable.

There is also a need for standards in social media measurement: a common language that is transparent, meaningful and able to drive strategy across organizations. These standards should also be applicable across disciplines and communities whether they are advertising and public relations agencies and their clients, academic researchers trying to decipher the inner workings of social networks, or program planners who need to decide if, when and how to allocate their resources to social media platforms. Common standards for social measurement should also increase the reliability of the methods that are used and the data that are presented to support the use and effectiveness of social media.

These were some of the arguments for setting standards for social media measurement at the 4th European Summit on Measurement by Tim Marklein and Katie Paine in their presentation of the work of the #SMMStandards Coalition. This group has identified six priorities for standardization:

Content sourcing and methods

Reach and impressions

Engagement

Influence and relevance

Opinion and advocacy

Impact and value

Here are some excerpts from their presentation:

Organizations need clearly defined goals and outcomes for social media.

Media content analysis should be supplemented by web and search analytics, sales and CRM data, survey data and other methods.

Evaluating quality and quantity is critical, just as it is with conventional media.

Measurement must focus on conversations and communities, not just 'coverage.'

Not all content venues, aggregators and analysts are created equal. Social media measurement success stands or falls on the quality, scope and methodology of content analyzed, as well as analyst experience.

Multipliers should not be used to calculate social media reach; in fact, dividers are more appropriate. Few of your followers “read” every tweet; only 8-12% see Facebook posts.

Engagement could be but is not necessarily an outcome and is manifested differently by channel.

Influence is multi-level and multi-dimensional, online and offline; it is not popularity or a single score.

Sentiment is over-rated and over-used; its reliability varies by vendor and approach.

Key performance indicators and balanced scorecards are helpful to connect social media impact to business results/language.

They also presented the first interim standard for content sourcing and methods used by vendors: "All social media measurement reports should include a standard "content sourcing and methodology" table that helps clients know "what's inside" the product for full transparency and easy comparison (like a food nutrition label)."

The #SMMStandards Committee is hard at work on the next steps including the publication of discussion documents on several of the priority topics. In the meanwhile, you can check for updates at #SMMStandards and start talking with your researchers and vendors about filling out a transparency table for their social media measurement sources and methods (see pdf example). Perhaps that will start moving us from black boxes and faith to data-driven decision-making.

The most important asset you can have in a social media marketing program is something worth talking about - not a “message” to listen to, read or watch. There are no markets for messages, or to paraphrase the Introduction to the Institute of Medicine (2000, p.5-6) Promoting Health report, people in the health and social change communities have “messages” while the individuals they are targeting in communities have “lives.” Having lives means, among other things, that people are talking to each other as opposed to talking to someone else (that might mean you). Why do they choose to talk to some people and not others? Mainly because they share something in common, whether it is a passion for bowling, their dogs, work, Star Wars movies, a local sports team, being in the church choir, or attending Charity Balls. Jyri Engeström and Hugh MacLeod have advocated for the idea that all social networks consist of people being connected by a shared object – whether it is an intangible idea or a physical thing.

The development of social media parallels this object-centered sociality: we have sharing and SNS designed around pictures, music, videos, jobs, dating, diseases, hobbies, places and especially friends. This feature of social networks is often overlooked by many social media programs that attempt to ‘build communities’ around the producer’s interests (aka messages and brands), not people’s lives. Social networks form around social objects, not the other way around. The value of a social object is that they are transactional – they facilitate exchanges among people who encounter them. People see or hear a social object (like a juicy piece of gossip, a cute animal video) and immediately want to share it with their friends who they believe will also find it interesting, useful or entertaining. But the point of a social object is not simply to have something to share; it becomes the centerpiece of a dialogue between people.

Too frequently social media efforts try and discover something for people to share and wind up creating objects that are viewed and then forgotten in the privacy of their rooms and offices. Creating objects that “creatively communicate messages” is not the social media challenge; creating things that people talk about with each other in ways that relate to your program’s objectives is the key to having a social object. Social objects are personal, active, provocative (or surprising) and trigger natural, enthusiastic sharing.

When you hear about successful social media programs, if you look closely you will find a social object embedded in it. The easiest way to tell is by what the people involved with it are talking about. You have to listen and engage with the conversation around thier social object to get the big results in social media - not try and change it to suit your agenda. Otherwise, your social media program is just another message machine. As J.P Rangaswami put it: "If markets are conversations, then marketing is about the things that conversations are about. Not about placing those things or promoting those things, but about the things themselves.”

She notes that there may be as much as $3.8 billion spent in advertising on Facebook in 2011. But are these marketers creating any value or sustainable advantage for their businesses? Her answer for most of them is "categorically no." Here's why:

Most marketers approach Facebook purely as an advertising and engagement platform. The select few who are getting it right recognize and approach Facebook as a new business-building capability.

Most execute programs only on Facebook.com. The select few who are getting it right also use Facebook off Facebook.com; using the open graph to develop relevant, compelling, personalized experiences on one's branded web properties.

Most measure the media activity (reach and frequency, impressions, buzz, fan count) only. The select few who are getting it right also measure commerce activity (referral traffic from Facebook and the resulting conversion on one's site, customer acquisition).

She provides recent examples of the right and wrong approaches to using Facebook - Amazon, Step2, TripAdvisor and Louisville Slugger (pay particular attention to this one as it parallels much of what I see happening in public health applications).

Paraphrasing her guidance of how to judge the success of your Facebook (and other social media) efforts, we need to address the questions:

What relevant and compelling consumer problem does it address?

How do your social media activities advance the behavioral and social change objectives of your organization?

"This erosion of anonymity is a product of pervasive social media services, cheap cellphone cameras, free photo and video Web hosts, and perhaps most important of all, a change in people’s views about what ought to be public and what ought to be private."

The first installment of what is described as an 'intriguing and provocative interview series with one of the world's most respected social marketing experts' is featured at fyi:health marcomms at the Path of the Blue Eye Project. The 10 minute podcast is devoted to an in-depth discussion of my recent post, 5 Fictions About Social Media for Public Health and Healthcare. We cover the pervasiveness of the 'reach and engage' strategy rather than an 'attract and join' one that leverages the power of social media; old models of targeting and directive behavior change (or persuasion) that don't fit with the nature of the social media space; the fears that interfere with 'best use' of social media; the current state of the science for effectively using social media in public health and healthcare (and how the lack of an empirical base allows for the spread of even more myths); and what are alternative outcomes to behavior change that we should focus on in our work using social media.

Hope you can listen and let me know what you think. And for those of you who will be attending the World Conference on Social Marketing next week, maybe we can pick up on some of the themes there. And a hint for those who will be there: at the Closing Keynote the future of social marketing is much bigger than social technologies ;)

Everyone has an opinion about the veracity, safety and privacy of health information on social network sites (SNS); now we have some data.

Investigators from the Children's Hospital Informatics Program evaluated the quality of health information on 10 social network sites (SNS) with an average membership of 6,707 that were organized around diabetes as the health concern. Among their findings were that only half of the SNS had content that aligned with clinical/evidence-based practice recommendations, while misinformation about a diabetes 'cure' was found on four moderated sites and three sites carried advertisements for unfounded cures (9/10 sites permitted advertising). Seven of the sites were hosted by for-profit entities and 3 belonged to professional organizations. In general, they found a high degree of variability in the quality and safety of the information provided on the sites, reports the American Medical News.

Their evaluation found privacy policies on 8/10 sites and on those sites they were within 2 clicks of the homepage. No policy was written at or below an 8th grade reading level (range 9.5.years - 18.4 years of education). The level of security to protect personal information was low - only one site used 2 of the three security indices and the rest used none or could not be determined. The security indices the researchers used were (a) privacy data storage using encrypted media, (b) data transmission through a secure socket layer, and (c) use of an external agent to audit security practices.

Overall, the results showed that the sites with the higher levels of alignment with diabetes science and clinical practice recommendations were most likely to have high levels of transparency and protection from misinformation. Only half of the sites were moderated, though this presence was not associated with less misleading information appearing on the site.

The report is valuable for, as the authors note, 47% of online adults in the US are engaging with SNS. This may be the first report to assess the quality and accuracy of the information published on these sites, as well as site privacy policies and practices.

"The phenomena [of social networking] itself in some ways is a big giant arrow pointing to some of the weaknesses, deficiencies or constraints on the traditional health care system and all its parts, whether it's patient education or advocacy or social support or effective communication" according to Elissa Weitzman, assistant professor of pediatrics at Harvard Medical School and lead author of the study that will appear in the Journal of the American Medical Informatics Association.

Based on the admittedly small sample of SNS, the authors urge patients, patient advocacy groups and medical communities to get involved with the oversight of online health communities. They recommend that sites:

• Identify where patients can get help and post guidelines for care. • Use credentialed moderators. • Enlist periodic external review of member discussions to protect users from misinformation and reinforce effective moderation. • Clearly flag commercial content and commercial members. • Ensure that privacy policies are easy to find and readable by the majority of healthcare consumers. • Provide for member control over sharing of personal health information. • Use industry standards to protect individual health information and sharing default settings that protect personal health information.

Thanks to Elissa Weitzman for a copy of the paper to verify and round out this report.

“We can reach and change the behavior of our target audience through social networking sites like Facebook and Twitter.”

This sentence captures the prevailing sentiment I find whenever two or more public health people gather to discuss their interest in social media and using it to advance public health goals. Notwithstanding the fact that their enthusiasm for these methods outpaces the development of an empirical literature to support their use, while also recognizing that the majority of US adults and teens are active users of these media, the sentence illustrates at least five misperceptions about the nature of social media and working in this space.

Fiction #1. We can reach audiences with social media

Many actors in the social media space, and this extends to users far beyond public health and the public sector, think of social media as another channel through which they can deliver messages to audiences. They view social media in much the same way that they have used broadcast and print media: as a tube through which they can deliver messages that will stick with and persuade people to change behaviors, purchase products or use services. They also greatly simplify the challenge, for example, by thinking of social media as consisting of only social network sites (SNS). As the chart Fred Cavazza created a few years ago shows, the social media landscape is more complex. Indeed, it is difficult to imagine that someone would undertake a television project believing that they can reach people by relying on CBS and FOX as their only outlets, but the analogy of using just Facebook and Twitter is lost on many.

Diving deeper into the Twitterverse - something Brian Solis and Jess3 have just mapped out - it is clear that each of the current social media darlings become even more complicated.

One reaction to all these opportunities is to be simply overwhelmed by them; and that's the point! Social media is not a new way to “reach” people - it is an 'attract and join' space. It is not a space with people sitting on a couch waiting to be entertained; this is a place where people actively seek out their own entertainment, and more importantly connect with their family, friends and people with whom they share similar interests.

The people we wish to engage with around specific issues need to be understood in the context of how they construct their social media space, not by how we construct it for ourselves. This idea became crystal clear to me during a project in which we were interviewing young, low-income women about their use of social media. Because we were already contemplating recruiting peer counselors, or evangelists, as part of a social marketing program to increase use of family planning services, we deliberately constructed focus groups consisting of women from this priority group who are currently enrolled in 2-year nursing or other health professional education programs. What we heard from these women was that they were now creating Facebook profiles because they felt they needed a more professional identity. These women had all been MySpace users and insisted they would continue being active there as well. Their comments solidified my POV, and reinforced what is reported by others and work being done on Personas at the MIT Media Lab: that many people use social media to create a variety of personas (I have a least 7 by their analysis). Most interesting in the research was the women's perception that having a Facebook profile signaled their transition into a new stage of their work life or career.

There are also circumstances in which public health people believe that there are groups who are not involved with social media. While there is some truth to this rumor, it is less veridical than many presume. The chart from the Pew Internet & American Life Project shows more than 50% of online adults between the ages of 18-55 use social network sites (SNS). More importantly, SNS are among the fastest growing online activities among 34-73 year-olds.

Fiction #2: We can change people with social media

This assumption is predicated on the idea that persuasive messages can be developed and delivered intact through social media to all of the people we wish to influence. This assumption often leads to the concern of "How do we ensure that our message is delivered as we want it to be?” Such people are used to the security of putting words onto a printed page, into a PDF format or a prerecorded radio or television spot where tampering with the message is designed out of the process. Indeed, the great leap that people must make when working with social media is designing content with the expectation that it will be passed on by others, perhaps edited or amplified, perhaps an opinion will be attached to it, mashed up with other content or even be responded to - rather than simply consumed.

Another underlying assumption is that people are active in social networks to learn things and are open to changing their behaviors. What we do know from surveys by the Pew Internet & American Life Project is that most people on the Internet are there to tap into their social networks. And people do not choose to be friends with people, or organizations, because of a promise that 'we are here to change you (or sell you something).' If we are to honor the notion that relationships through common interests are the basis on which social networks are developed, then we also must recognize that people on SNS are not looking for people to change them. To return to the 'attract and join' position, the early experiences we have using SNS for behavior change efforts in these networks and communities tend to attract like-minded people who are either looking for ways to support their own change efforts that are underway, or to discover resources they can use or to help others make the same change - for example, people who are attempting losing weight or who have quit smoking.

The third variable in the 'change' presumption is that it will occur through individual, or psychological, mechanisms. This perspective overlooks the value of working in the social media space: that is, directly addressing some of the social variables that influence behavior, as well as improving social connections and social capital in online communities. I've written quite a bit about social influences, social networks and health behaviors. My bottom line is that we are being forced by the explosion of social media to face the reality (and some might say - "again") that social networks frame the opportunities and constraints for change.

Fiction #3: Health behaviors are the focus of our social media efforts

Many people who undertake social media efforts targeted at behavior change assume that people interact with social media much like they do with broadcast media - that is, very little. People on social media sites are not sitting in front of a computer screen simply switching channels or adjusting the volume. They are reading news and updates from friends, searching for information, sharing with others, making new friends, rating products and services, tagging content, posting and uploading content, linking to content as well as retweeting it - to name just a few behaviors that will affect their ability, as well as ours, to effectively engage with each other for a common purpose of learning and acquiring new behaviors. Overlooking these component skills may be the greatest risk to public health programs that are delivered via social media.

To briefly illustrate this point, we must understand that segmentation is not just about the behaviors that are of interest to us, our organizations or society. Rather, we also need to include in our segmentation schemes the fact that there are social media behavioral segments that need to be incorporated into the design of our programs. For example, Forrester Research (2006) has identified six segments they label as Inactives (over half of US adult online users), Spectators, Joiners, Collectors, Critics and Creators.

Preece & Schneiderman (2009) have a similar behavioral segmentation scheme they call the “Reader-to-Leader Framework" which should be required reading for designers of behavior change programs in SNS or online communities. In their paper they give a number of both technological and social prompts that can help guide people through the process of moving from a Reader to a Contributor, Collaborator and Leader role.

What both of these segmentation strategies highlight is that many people who are on SNS or online health communities participate at very low levels of activity. This finding should make some people pause and question their assumption that behavior change through social media is simply presenting the right message, at the right time, to the right audience.

Fiction #4: We have target audiences who use social media

At a superficial level, this assertion it is true. However, the presumption that a target audience is waiting for us to reach, touch, engage them or otherwise treat them as passive consumers is a sure route to failure. As most people soon learn, in the social media space the targets can shoot back.

So it is little wonder that when organizations intend to use social media that much of the early planning centers around questions of how open the organization will be to comments and participation, whether and how to create content that people can modify - or not, whether to involve people formerly known as the audience as co-creators of content and whether to design program elements that allow people to actively reach out and engage people in their own social networks in the change process (that is, become extenders or evangelists for the cause).

Thinking of people in SNS or online communities as “target audiences” also fails to acknowledge that in the social media world it is not about audiences, but communities. I see this bias arise when agencies begin thinking about creating their own communities before understanding whether there might be existing online communities that they could join.

The most important opportunity that letting go of the “target audience” mindset provides us is that we can leverage and facilitate the interpersonal, or word-of-mouth, communication that naturally occurs in these networks and communities. If we approach social media without a “consumer” frame, we can then think about how we can utilize the most significant influencer for new learning and behavior change - interpersonal communication. Adopting this perspective makes it easier to understand why we have to let go of our content, unlock the formatting keys and make the content accessible to people who can then pass it along to others. (More on The consumer as participant rather than target audience - pdf).

Have you truly thought for all these years that people either heard or saw your content and said nothing to anyone else, or if they did repeated it perfectly? Only with the advent of social media, and the ability to experience these second- and third-hand transactions, does the question seem relevant. But that does not change the fact that people have been talking about our messages and content for years; we just weren't able to watch or hear it (maybe we just weren't interested - or now we think we can be held accountable for what they say).

Fiction #5: To use social media effectively we need to be on Facebook and Twitter

The prevailing wisdom is that using Facebook and Twitter are the keys to success in the social media world. In most cases, this presumption is based on the numbers of visitors that go to these sites rather than any understanding of whether our priority groups do or whether those sites are the best place to try and engage them in behavior change or community building activities.

It is also important not to rush past other Internet assets just to be part of the social media dance. As John Mack of Pharma Marketing Blog illustrated from a recent Accenture survey, social media sites are the ones health information seekers are least likely to visit - lagging behind online patient communities, pharma websites and general and medical websites such as Wikipedia and WebMD. This calls for carefully considering your objectives and the way your priority group uses the internet and SNS before jumping to the Facebook and Twitter default.

Decisions about where to focus your social media resources may also contribute to widening health awareness, information and status gaps among users who use the sites and those who don't. It is also well worth considering whether sites like Facebook deserve the attention of public health organizations at all. For example, when one looks at the groups of people most deserving of public resources, and among whom some health problems may be more prevalent, MySpace may be more important. danah boyd noted several years ago that 'MySpace has most of the kids who are socially ostracized at school because they are geeks, freaks, or queers.' MySpace has always been the habitat for people outside the mainstream and ignoring that fact, and that there are millions more of teens and adults like them in various ways, lends an urgency to getting answers to questions of 'how can we attract and join with people who hang out on SNS to promote and support more healthy choices in our everyday lives?'

Now that we have these five fictions on the table, what would you like to do next?

Over the past decade there has been a dramatic shift in the emphasis of determinants of health and social behaviors from individuals to networks and communities. For example, in three major areas of interest for public health officials and social marketers – the prevention of HIV infection, obesity and tobacco use – the role of social networks in disease transmission and the prevalence of risk behaviors is creating new opportunities for both concepts and practices that focus on social units of analysis, change and outcome.

Concurrent sexual partnerships, that is, having two or more stable sexual partners over time is being seen as one of the previously hidden drivers of the HIV epidemic. Concurrency, especially when the partners are sexually active with others in a small world network (see below), heightens the risk of HIV transmission because these relationships are not casual or one-off sexual encounters, but are maintained over time where a level of trust develops that diminishes their perceived riskiness. Thus, when one partner becomes infected, they are highly likely to have sex with one or more other partners during the window of greatest HIV infectivity. Developing interventions to address the network effects of sexual activity are only just beginning.

Similarly, the work of Christakis & Fowler (2007, 2008) provides descriptive evidence that the likelihood of becoming obese rises as close members of one’s social network become overweight and obese and that stopping smoking is also highly susceptible to the smoking status of others. Again, the implications for interventions are only now being explored. However, it is clear that simply focusing on individual and/or environmental determinants of these conditions can no longer be a singular pursuit for social marketing or any other type of risk reduction programs.

The world of social network theory introduces us to an entirely new set of concepts and ways of thinking about human behavior and the social forces that directly influence it. Goyal, for example, posits that individual choices related to the gathering of information for making behavioral choices are shaped by the pattern of connections between people in a society. Three core network properties he discusses are (1) degrees or how many links each member in a network has with others; (2) clustering – how dense the connections between members of a network are; and (3) average distances or how far away from one another each person in a network is from another in terms of the number of links necessary to reach them (popularized as “6 degrees of separation” or “the Kevin Bacon game”). A network that is characterized with small average degrees (everyone has at least a few connections with others), high clustering (they mostly connect with others in the network), and small average distances (there are few degrees of separation between them so that most people know or are at least acquainted with most of the others) are referred to as small world networks (Watts and Strogatz, 1998). Recall that these closed networks are less likely to adopt innovations or new evidence-based recommendations (a new take on ‘the old boys network’).

One of the implications of this work with social networks is that people learn about and choose among behavioral options not only based on directly observing others in their social circle engage in behaviors and the consequences they experience, but also by whom their friends and associates connect with outside that proximal network and then bring that information or those practices back to the immediate network. Goyal (20070 concludes from his review of empirical work in economics and social networks that variations in behaviors among individuals are related to not only the connections people have within the same social group, but also from their being members of different groups as well. The implications for social marketers seem clear; who people associate with, or are connected to, must be considered and addressed by intervention efforts. These network variables, in turn, might also serve as intervention points by, for instance:

1. focusing on people with large numbers of connections within a network (connectors, influentials, or opinion leaders);

2. reducing the density of a network in which risk behaviors are concentrated by introducing more boundary spanners or increasing social connections of members of the group outside of their immediate network;

3. understanding the members of a network who are most attentive and responsive to the behaviors of others (or more easily influenced or persuadable) and providing them with protective or alternative behaviors to prevent adoption;

4. and enhancing the salience and attractiveness of the ‘out group’ [positive deviants] by positioning these practitioners of desired behaviors in a way that attracts imitation or modeling.

Social network analysis must also be sensitive to information asymmetries that will exist among individuals within a group as well as between groups. Viswanath and Kreuter point to the existence of communication inequalities as possibly underlying many of the social inequalities we see in health risks and conditions. These communication inequalities are manifested as differences among social classes in the generation, manipulation, and distribution of information at the group level and differences in access to and ability to take advantage of information at the individual level. As a consequence, communication inequalities may act as a significant deterrent to obtaining and processing information; in using the information to make prevention, treatment and survivorship-related decisions; and in establishing relationships with providers.

Social networks have also played a major role in the development of the so-called Web 2.0 in which collaborative and dynamic models of communication underlie the philosophy, software development and user behaviors. The ubiquity and popularity of blogs and microblogs, social network sites, social sharing sites, wikis and virtual worlds have made the network connections among people more obvious. And, more importantly, these social media have unleashed a set of tools and resources that allow the people formerly known as the audience to create content for themselves and to tap into pools of collective wisdom. Social marketing programs must adapt to be both relevant to people’s (new) lives and to harness this collective wisdom and power for social change.

Similarly, the explosion in the adoption of wireless communication technologies, notably mobile telephones and smart phones, are enabling communications that transcend place-based methods (‘we call to individuals, not places’; Ling, 2008) and are further driving home the idea that people are communities, not individuals (Ahonen & Moore, 2005). As I have said elsewhere, while we have always been aware that there are social influences for many of the individual behaviors we seek to influence for environmental protection and the improvement of public health and social conditions, social technologies are changing the weights we use in our models of determinants of behavior and the ways in which we approach changing them. Given all of this, in the future let’s consider the consequences and implications of adopting a social networking perspective into our work as social marketers:

• How can we enhance linkages that already exist among people, organizations, and communities to allow them to access, exchange, utilize, and leverage the knowledge and resources of the others?

• How do we help develop, nurture, and sustain new types of linkages that bring together like-minded people, mission-focused organizations, and communities that share interests to address common problems and achieve positive health and social change?

• How do we identify, encourage and enable the many different types of indigenous helpers that are found in social networks so that they can be more effective in promoting positive health, environmental and social behaviors and policies?

• What do we do to better engage communities in monitoring, problem analysis, and problem solving; striving to health and social equity; and increasing social capital?

• How do we go about weaving together existing social networks of individuals, organizations and communities to create new sources of power and inspiration to address health and social issues?

• How does a networked view of the world disrupt our usual ways of thinking about and engaging the people, organizations, and communities with which we usually work? What are the insights we can gain from this perspective?

Clearly we need to dig much deeper into social netwrok theory to understand the dynamics of diffusion and change of various types of health behaviors. More importantly, we need to develop and test programs for which change among social networks and connections are a primary focus of our efforts. Where information and communication technologies may evolve to in the next few years is an open question. But blending social media tools and mobile technologies with social marketing to capitalize on and impact social networks is also an area for further exploration in achieving scalable results for networks of healthy people.

References

Adimora, A.A., Schoenbach, V.J. and Doherty I.A. (2007). Concurrent sexual partnerships among men in the United States. American Journal of Public Health, 97: 2230-2237.

ABSTRACT: The Obama campaign has relevance for how we
conduct and build communities around our public health campaigns. As such, an
understanding of how new media was used in energizing the public in the Obama
campaign is worthy of reflection. The Obama campaign’s use of new media can be
grouped into those applications related to: 1) the campaign website, 2) the
campaign TV channel, 3) social networking sites, and 4) mobile phones. The
authors also briefly describe 5) the campaign materials created by supporters
which made use of new media, as these also contributed the campaign. The
authors briefly describe each of these and, where available, provide indicators
of use by the public. Then, through the lens of public health communication
principles, the authors discuss what seems to have been effective about their
efforts, and how public health campaigns can make use of similar strategies in
the future. [Journal of Health Communication, 14:415–423, 2009]

Social media users from public, private and NGO sectors are increasingly using social network sites (SNS) as part of their efforts. Usability maven Jakob Nielsen looks at the problems with outsourcing social media functions to platforms like YouTube, especially when linked from enterprise websites. The key risks involve lowering the usability of the primary site while also risking losing potential viewers (having less loyalty and losing value to search engines).

...there's no doubt about the everyday design implications of hosting any
material on other sites. Don't just use the default template, and
definitely don't assume that simply dumping stuff onto a popular SNS
will automatically make you popular.

The glow of the Obama campaign and its ability to mobilize people has certainly dimmed in the past few months. When it comes to whether the internet is stimulating an increase in social action and making it more accessible to all, however, a new report by the Pew Internet and American Life Project on The Internet and Civic Engagement concludes:

Contrary to the hopes of some advocates, the internet is not changing the socioeconomic character of civic engagement in America. Just as in offline civic life, the well to-do and well-educated are more likely than those less well off to participate in online political activities such as emailing a government official, signing an online petition or making a political contribution (p.3).

Though the survey does find a smaller gap between younger and older adults with respect to measures of civic engagement, the overall findings still suggest that within any age group socio-economic status (SES) remains the highest correlated variable. They also find that about 1 in 5 adult internet users have posted content about a political or social issue or in some other way used a social network site [pdf] for other forms of civic engagement. In what may signal changes to come in online civic engagement, these latter internet users are less likely to be characterized by higher SES levels. These online adults are also more likely than people not engaging in political and social actions to be active offline as well. And over half (56%) of these active online adults use digital tools such as email and group websites to communicate with each other.

The great paradox for communicators and
marketers is that while we give rhetorical priority to concepts of
interactivity and audience-focused programs, we continue to hammer away
at “breaking through the clutter,” “capturing people’s attention” and
“getting people to do things.” Yet, even before the emergence of social
media the music was already echoing off the walls: It’s no longer about getting attention, it’s about earning it.

This presentation describes a scale for measuring the engagement properties of eHealth content that was adapted from commercial advertising research. Accompanying research suggests that a 9-item revised eHealth Engagement Scale is a robust tool to operationalize this concept across a variety of health topic areas. The eHealth Engagement Scale may prove to be an important mediator of user retention of information, intentions to change, and ultimately efforts to undertake and achieve behavior change.

There are many different ways to think about engagement. This scale begins to get at the consumer/user experience of engagement that we define as the process of involving users in health content in ways that motivate and lead to health behavior change.

'Increasing the engagement of people' with advertisements, brands, communities, issues and media gets thrown around by many, however, rarely do I see someone operationalize it beyond eyeballs and clicks.

From our scale:

Engagement = Involving + Credible + [not dull + hip, cool]

See the presentation for more details, including the path model, and I look forward to your comments!

Encourage horizontal (i.e., peer to peer and social network) communications of campaign messages as social influence and modeling are important drivers of behavior. Embrace user-generated messages and content, especially in the case where top-down campaign messages are straight-forward and translatable by the public.

Use new media to encourage small acts of engagement. Small acts of engagement lay the groundwork for relationship building and larger tasks in the future. are important for relationship building and can lead to larger acts of engagement in the future.

Use social media to facilitate in-person grassroots activities, not to substitute for them.

Chris Aarons and Geoff Nelson look at failed social media campaigns and make this list of suggestions to avoid the common problems and expectations people have when embarking on social media efforts.

Good strategy results in viral, but viral is not a strategy.

What someone says about you is more important than what you say about yourself.

People are already motivated to do many different things. By identifying where their motivation intersects with yours, you can avoid creating a contrived campaign. However, if you are ready and able to compensate people for their effort, the likelihood of participation goes up exponentially.

Money isn't the best social currency; relationships and knowledge are.

PR is great for news and launches, but social media creates the ongoing and sustained interest between news and launches.

Buying advertising space on social media sites doesn't return a quarter of the value you could be getting. Further, the costs of the campaign drive up the ROI bar you need to justify it.

Social media sites, people, and applications have vastly differing capabilities. Random, unplanned usage of these tactics will deliver poor results.

Social media is a strategic amplifier for your campaign, not the entire campaign.

Jacob Nielsen, the guru of usability testing, has a new Alertbox on Social Networking on Intranets that is worth the read. From 14 business case studies he draws five conclusions (direct quote):

Underground efforts yield big results. Companies are turning a blind eye to underground social software efforts until they prove their worth, and then sanctioning them within the enterprise.

Frontline workers are driving the vision. Often, senior managers aren't open to the possibilities for enterprise 2.0 innovation because they're not actively using these tools outside of work. Indeed, many senior managers still consider such tools as something their kids do. One of the dirty secrets of enterprise 2.0 is that you don't have to teach or convince younger workers to use these tools; they expect them and integrate them as easily into their work lives as they do in their personal lives.

Communities are self-policing. When left to their own devices, communities police themselves, leaving very little need for tight organizational control. And such peer-to-peer policing is often more effective than a big brother approach. Companies that we studied said abuse was rare in their communities.

Business need is the big driver. Although our report discusses specific tools (blogs, wikis, and such), enterprise 2.0's power is not about tools, it's about the communication shift that those tools enable.

Organizations must cede power. Using Web 2.0 technologies to communicate with customers has taught many companies that they can no longer control the message. This also rings true when using Web 2.0 tools for internal communication. Companies that once held to a command-and-control paradigm for corporate messaging are finding it hard to maintain that stance.

In his discussion he also has some comments about community management, participation inequalities, tagging and rating systems and the reciprocal influences of social media and corporate culture.

And concludes …social software isn't really about the tools. It's about what the tools let users do and the business problems the tools address.

The strategic use of social media is about changing your perspective, not using new communication tools. The talks I give about social media and social marketing these days focus almost exclusively on the shift we need to make in how we think about interacting with people formerly known as the audience and much less on the tactics, or how to use specific social and mobile media tools. Fortunately, in the past four years, many social marketers and change agents have emerged to fill in those gaps. But the pace of adoption of social media in public health and social marketing programs is outpacing the understanding that social media is not simply a new set of communication tools to substitute for, or complement, posters, pamphlets, PSAs and publicity events.

A number of points about strategy and social media came together for me over the past few days as I have been consulting on five different social media projects at various stages of development. The contours of the issues each project faces are specific to the environment they are percolating in, but the repetitive themes that kept coming to the foreground – and my response to them, equally repetitive - brought me to writing a few of them down to share here.

The issues revolve around the self-defining question of what should be the role of a sponsoring organization when launching social media efforts?

The default positions most people gravitate towards come from the old model of communications – develop ‘innovative’ or ‘pilot” projects that use various social media tools (usually Facebook, Twitter and widgets, maybe a blog – rarely a mobile strategy or MySpace and never a wiki, building relationships with bloggers or working with existing local social network sites). A few groups recognize the value of co-creation of content, but have little idea of where to start and have the expected jitters about how all that will work out IF they were to try it. Somehow many people become amnesic that we have always had essay, photo, poetry and other types of contests to elicit content from ordinary people. Somehow, it has become sooo – sinister, subversive, sexy?

A slightly more enlightened position to assuming the familiar role of content creator is to become the expert consultants or coaches for others – provide training and technical assistance to the newbies in the organization, state, or whatever. What will they teach? Mostly how to use the new media in old ways.

What I believe are the more powerful positions to take, and here I mean by powerful the strategies that exploit the features of the social media, and not simply put old wine into new bottles, are to become collaborators, conveners, facilitators, brokers and weavers. By collaborators, I mean working inside what others have created – existing blogs, social network sites; creating platforms for group participation from the beginning – not just as a glorified dissemination website. By conveners I think about using social media in new ways to bring people of common purpose together to get things done – not simply substitute computer-mediated (not even in Second Life) meetings for in-person ones (aka the burgeoning scheduling of ‘webinars’) to ‘talk.’ One of the major barriers to becoming a convener is that few people and organizations understand the effort that must go into changing the behaviors of their collaborators (for a recent discussion I recommend Preece, J. and Shneiderman, B., The Reader-to-Leader
Framework: Motivating technology-mediated social participation in AIS
Transactions on Human-Computer Interaction 2009;1:13-32). Brokers implies becoming a dynamic resource center – not a place where people go to check out job posts, download toolkits and case studies, but where people can, among other things, exchange advice and information, solicit creative work, comment on works in progress, allow agencies to see who outside their usual networks might have the ways and means to reach priority groups. For example, why do so few health programs reach poor, underserved and rural populations through agricultural extension services? Why do federal health agencies work so closely with state health departments for pandemic flu preparedness when they clearly do not achieve the presence that is necessary for an informed public and prepared and responsive smaller public health agencies (is there some presumption of trickle-down communication)? And finally, agencies and organizations need to think about themselves as network weavers – pulling together what are usually (when you look for them) a number of diverse and isolated groups working on the same problem but do not have the connectors, or bridges, to bring them into contact with one another. When I suggest creating a collaborative platform for the program, the default response is to move all the usual suspects onto it – and not see it as the way to engage the local groups, advocates and affected groups in the effort. Their response is - how will we manage all of them?! Maybe a first step is to believe in the power of groups and social networks to self-organize. But that’s another story for another post.

Using social media means embracing the idea that the world is composed of social networks, not individuals. In my talks I distinguish between the old world of sources, channels, messages and receivers (a convenient fiction reinforced by the dominance of broadcast media for several decades) and the new world of distributed social media where anyone can be a producer and distributor of information. This new world focuses us on the engagement of people, not trying to creatively break through clutter; the idea that people are continuously interacting with each other and yes, will talk back to you (the secret is they always were, you just could not hear them); and the need for multiplexity – that in the new world of masses of media, and the personalization of one’s media environment, it is ubiquity that is important – not being on Facebook or Twitter. And yes, I do see people creating tactic-driven strategies. It goes like this: we want to use Twitter – or some other social media tool - because it’s cool, or someone really wants us to, or everyone else is doing it. So how can we rationalize it by creating a strategy that makes sense for us to use it? Forget what the original objectives of the campaign were – we can change those too. You get the circularity of the argument.

Understanding that it is a social world means shifting our thinking from individuals to the connections between them. As I put it today, focus on using social media to take advantage of the connections people have with each, not to reach people in new ways. What we find when we do this is the challenge of ‘making something go viral’ – a core wish of all social media toolmakers – becomes more clear. The challenge has to be framed: how do we design experiences people want to share, rather than simply how do we design something that is entertaining and changes their behavior (whoops, that old mentality slipping in again). That is how behavior and culture can be shaped, changed, shifted. Through people exchanging with each other. And once you get to that place - that we all live in a marketplace of ideas, behaviors, products and services. That people we wish to serve are not a horde of individuals only calculating costs and benefits for behaving (performing?) in self-interested ways. But people forming and participating in any number of social networks through shared social objects, beliefs, customs, norms that in turn influence their and our behaviors.

Some of those people we use to call audiences, and others we call our co-workers and partners. Others are people working in what use to be thought of as disparate fields, agencies and lands. New technologies have made it clearer than the theorists ever could that we are all connected in many different ways. Social media gives us the tools to discover and transform these relationships, not just pay rhetorical homage to intersectoral collaboration, busting out of silos, reaching across departments and offices, nurturing and sharing collective wisdom and experience (wherever it may be), engaging the public and building social capital, and leveraging scarce resources. But first it means as social marketers that we need to think about social media as a means for pursuing social strategies for making the world a better place for all the people that live in it. And then as a way to transform how we go about doing our work.

Social media emerged from the breakout rooms of past years at the Social Marketing in Public Health Conference to the Plenary Session this past Friday morning. With Paul Gillin and Bob Gold, we designed this 2 hour session to focus our presentations on the shifts in thinking brought about by social media and other new technologies and then allow about an hour for audience discussion and questions. A recurring theme across all our talks is captured in this picture from Lynette Webb.

My introductory comments followed much of the same trajectory as the presentation at the APHA social media and risk communication roundtable a couple months ago. My key themes revolved around the challenge of masses of media vs using mass media; personalization of social media use; thinking about social networks, engagement, interactivity and multiplexity rather than sources, channels, messages and receivers; communities, not audiences; mobility (cellphones); and that most people use the internet for tapping into social networks (not looking for information).

As we listened to the rest of the morning’s speakers and discussion, I proposed answering these four questions for how social media poses opportunities for social marketers and their mix of marketing strategies:

How do I add social media features to my behavior change products, services and programs?

How do I use these technologies to overcome psychological and social barriers (costs) people have to engaging in new behaviors, develop new incentives and reinforcers and create new ways of providing social support to people who are trying to change behaviors?

How can I place-shift; use SNS, co-presence and virtual worlds; and add GPS to create scalable behavior change programs?

How do I facilitate conversations among people, not aim messages at them?

Paul Gillin picked up on several of these themes, beginning with the changing landscape of marketing media including the observations that teens watch 60% less TV and are online 600% more than their parents; in 1965, 80% of consumers could be reached with three 60-second TV spots - in 2002, that same reach required 117 TV spots.

He also spoke of the rise of information democratization. He noted the many different ways there no are to interact with consumers and not just talk at them. He used several case studies to illustrate social media ‘gone wrong’ including the J&J Motrin backache ad and the consumer backlash it generated of more than 15,000 tweets, 400 media stories and 3,500 blog entries they had to contend with.

Bob Gold opened his part of the plenary with his perspective on eTools and social marketing :

We have enormous technical capability; most of which is underutilized

Applications have not yet caught up with the technical capacity of hardware

eTools is plural

The only digital divide is in our own minds

Effective use of eTools benefits everyone

The greatest mistake we make is in using eTools in ways that reflect what we do best and what we most enjoy doing

Why, we asked, could we harness technologies to do such things as land a man on a moon (which he pointed out was done with less computing power than most people in the room have in their cell phones), read ancient texts but not social interactions, decode the human genome but not how children learn, build impressive structures such as the Taj Mahal but not healthy communities, and have so many best practices such as the Guide to Community Preventive Services but not get practitioners to use them effectively?

Bob also focused on how we need to use these new technologies to enhance how we do our own work. He illustrated this by showing people how Google is more than a search engine, but a whole suite of productivity tools. He demonstrated Newsmap as a way for public health officials to understand what the important health issues are for media now. And he closed by showing a clip from Project Natal, one that when you see it, brings home the idea (and feeling) that it is indeed “tomorrow’s technology today.”

The challenge is: how do people in public health, and especially in social marketing, begin to tap into these technologies to do our work bigger and better? The discussion that followed barely scratched the surface, and it will take meetings dedicated to this question, and much experimentation and prototyping, to come up with reasonable answers.

Note: This was also the first Social Marketing in Public Health Conference to have a host of tweeters using #smph. You can follow what they were hearing and thinking about during the sessions.